The Centre for Law and Policy Research is preparing to file a lawsuit.

On Nov. 27, 2016, four transgender individuals were arrested and sent to Bengaluru Central Prison, accused of abduction and attempted murder, among other things. One, Ishu, had undergone breast augmentation surgery in October 2016, and developed an infection in her silicone implants while she was in jail.

Ishu, who was 19 at the time of her arrest, according to a police document, told the prison medical officer, but received only generic painkillers for a few days.

Prison officials finally sent her to an outside hospital for treatment, but only after lawyers for the Centre for Law and Policy Research, who advocate on behalf of transgender inmates, intervened.

"It was a great lapse in medical treatment. It stemmed from two reasons - general apathy and disregard for the well-being of transgenders, and more importantly lack of preparedness of medical officers within prison to deal with such cases," said lawyer Ramya Jawahar Kudekallu of the Alternate Law Forum.

Ishu's case highlights one underexplored area of how India treats transgender people: what happens when they run afoul of the law and are sent to jail?

At present, there are six transgender undertrials (persons on trial in a court of law) lodged in the prison at Parappana Agrahara, Bengaluru. The prison declined to make any of them available for comment.

Last year, the Karnataka government created separate cells for transgender inmates at the prison. "We do not have separate barracks for transgenders. But, we house them separately within the women and male wards," said prison superintendent Dr Anitha.

Once transgender individuals are brought to prison, they are sent to the chief medical officer. If they have female genitals, they are classified as women. So it goes for those with male genitals.

This goes against a Supreme Court 2014 judgment that said "the gender to which a person belongs is to be determined by the person concerned".

Anitha said it's impossible to comply. "How can we place them in the women's ward if they are male physically?"

The result oftentimes is bad for transgender people. They are prone to bullying by other inmates, physical and sexual assault and deprivation of medical attention.

"Most medical professionals employed in prisons across the state are ill-equipped to look after transgender individuals," said Kudekallu. "There is also general apathy and a sense of ridicule that creeps in, as we saw in the case of Ishu."

The Indian government allocates funds to all prisons for expenses including food, clothing, medical facilities, vocational activities such as training in agriculture, carpentry, tailoring, weaving and other trades, and welfare programmes. A 2015 report by the National Crime Records Bureau shows that 6.34 million rupees (around $93,000) of the total expenditure incurred by Karnataka jails in 2015-16, or 1.62 percent of the total, was spent on medical provisions.

"We try to look after all inmates. Even in case of the transgender inmate whose silicone implant got infected, we provided prompt medical treatment," said Anitha.

"She was provided painkillers in the beginning. Later, when symptoms persisted, she was referred to Victoria Hospital. She is slowly recovering."

Anitha said there is no bias against transgender people in providing medical aid to inmates.

The system to some extent suffers not from people's biases, but their lack of knowledge about dealing with transgender individuals. Take for example HRT or hormone replacement therapy.

Most transgender individuals who choose their gender require hormone replacement therapy, in which sex hormones and other hormonal medications are administered to transgenders to synchronise their secondary sexual characteristics with their gender identity. Once incarcerated, it is impossible to get these hormones.

Anitha said she did not know about hormone replacement therapy. The prison's chief medical officer, Dr. Kalasagouder, said "no form of hormone treatment is provided to transgender prisoners and if [transgender] prisoners ask for it, they will be referred to a higher centre for specialist opinion. As per their advice and if course of treatment is provided, action will be taken."

The Centre for Law and Policy Research (CLPR) in Bengaluru is preparing to file a lawsuit on transgender health for inmates.

"It is a thoroughly neglected area and one that results in a lot of abuse and harassment," said CLPR lawyer Jayna Kothari. She said the group successfully challenged Section 36-A of the Karnataka Police Act, which allowed the police to keep a transgender registry that legitimised criminalisation of transgenders as a group.

Advocates say it's not just in Bengaluru where transgender inmates face assault and bullying, but in prisons and jails in other parts of the country as well. "After Ishu's case, we realized that healthcare within prison is abysmal and needs to be changed," Kothari said.

Anitha said prison authorities would be able to address medical issues of transgender inmates if provided with proper guidelines.